Antiretroviral Therapy Efficacy Post-Bariatric Weight Loss Surgery: A Case Series of Persons Living with Human Immunodeficiency Virus

Abstract

Purpose Human immunodeficiency virus (HIV)–related mortality has decreased secondary to advances in antiretroviral therapy (ART), and the incidence of obesity in this population is increasing. Bariatric surgery is an effective method of weight loss, though changes in the gastrointestinal tract may affect ART absorption and virologic suppression. Existing data are limited to case reports studying outdated therapeutic regimens; studies evaluating modern ART regimens are needed. The objective of this study was to determine if undergoing bariatric surgery impacts HIV virologic failure rate at 12 months post-surgery and to characterize the failure population. Materials and Methods This retrospective case series included adults with virologically suppressed HIV on ART who underwent roux-en-y gastric bypass (RYGB) or sleeve gastrectomy (SG) surgery between 2000 and 2019 (n=20) at one of three medical centers within one academic medical system. The primary outcome was proportion of patients with ART failure at 12 months post-surgery. Select additional data collected included CD4+ count, metabolic parameters, postoperative complications, and medication non-adherence. Results A total of 18 patients were included in this analysis. Seventeen of 18 patients (94%) maintained virologic suppression within 12 months post-surgery. There were no significant changes in CD4+ counts before and after surgery. The one failure was an African American woman who underwent sleeve gastrectomy surgery. This patient’s baseline viral load was undetectable and CD4+ count was 263 cells/mm3. Conclusion Undergoing bariatric surgery did not increase virologic failure rate in a small cohort of persons living with HIV, and ART non-adherence was associated with virologic failure. Graphical abstract

Metabolic and Bariatric Surgery for People Living With HIV—A Propensity-Matched Cohort Study

“…The weight loss result seen in our study supports the results of previously published smaller studies evaluating weight loss among PLHIV. [9][10][11][12] Although a few patients experienced good weight loss after SG, the distribution was wide. RYGB seems to result in a greater and more reliable weight loss compared with SG at 2 years after surgery in PLHIV.…”

“…These alterations may influence absorption and bioavailability of orally administered drugs and thereby lead to subtherapeutic doses of important pharmacological treatments, such as ART. 8 Although the available literature on MBS in PLHIV is limited, previous studies suggest that surgery may be safe with good postoperative control of the HIV infection, [9][10][11][12] without increased mortality rate. 13…”

Efficacy and Safety of Bariatric Surgery in Dutch People Living with HIV: a Retrospective Matched Cohort Analysis

“…Overweight and obesity trends are increasing across all populations, including people living with HIV (PLWH). Nowadays, the prevalence of obesity in men and women living with HIV is about 19% and 49%, respectively [ 1 ]. The high prevalence of obesity in PLWH is parallel to those in the general population, because of a shared obesogenic environment [ 2 ].…”

“…The high prevalence of obesity in PLWH is parallel to those in the general population, because of a shared obesogenic environment [ 2 ]. Additionally, advances in combination antiretroviral therapy (cART) have significantly improved survival in PLWH allowing for similar aging-driven health problems, such as obesity [ 1 , 3 ]. Moreover, cART initiation is likely to contribute to weight gain in PLWH [ 1 , 4 ].…”

“…Additionally, advances in combination antiretroviral therapy (cART) have significantly improved survival in PLWH allowing for similar aging-driven health problems, such as obesity [ 1 , 3 ]. Moreover, cART initiation is likely to contribute to weight gain in PLWH [ 1 , 4 ]. Several mechanisms of weight gain after cART initiation have been proposed, including a reversal of the accelerated catabolism characteristic of an active HIV infection, and resolution of gastrointestinal dysfunction that could adversely affect appetite and nutrient absorption [ 5 ].…”